Form 3-2327 Federal Subsistence Designated Hunter Application Hunt R

Federal Subsistence Hunt Application
Federal Land Unit:

Permit No.

PERMIT NO: PERMIT_NUMBER

Unit(s) & Subunit(s):

Applicant’s Name (First, Middle Initial, Last):

OMB Control No. 1018-0075 Expires 06\30\2019

DESIGNATED HUNTER
FEDERAL PERMIT

Date of Birth (mm/dd/yy):

UNIT: State wide specific to
permit being designated
SPECIES:

Mailing Address:

AK Hunting License Number:

Physical Address: PHY_ADDR_SAME

Telephone Number:

SEASON:

Community of Primary Residence:

Name of Recipient

Hunting
License #

Permit /
Ticket #

__________________ ________ _________
Applicant’s Signature

Issuing Agent (Print):

__________________ _________ _________

X ____________________________________________________________________

Date Permit Issued (mm/dd/yy):

__________________ _________ _________

I certify that I am a rural resident as defined by 50 CFR 100.4 and 36 CFR 242.4. I have read and understand the conditions on the permit and agree to
comply with them and applicable regulations as found in 50 CFR 100 and 36 CFR 242 .

__________________ _________ _________

Federal Subsistence Harvest Report
Permit Number:
Permittee’s Name:
Did you hunt as a Designated Hunter?
Yes ___ No ___
List All Persons for Whom You Hunted:
Permit /
Name of Recipient
Ticket #
Harvest Location

C = Caribou S = Sheep
D = Deer
X = Muskox
M = Moose G = Goat
Unit /
# Harvested
Subunit Species Male Female

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4. PLEASE MAIL - Thank you for your cooperation.

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NON-TRANSFERABLE:

_________________ _________ _________

SPECIES:

__________________ _________ _________
HUNT CONDITIONS: See Back

SEASON END:

USER_NAME
DUE DATE:

Designated Hunter: means a
Federally qualified subsistence
hunter who may take all or a portion of another Federally qualified
hunter’s harvest limit(s) only under situations approved by the
Board.

_________________________________
Print Name
X___________________________________
Hunter’s Signature

FWS Form 3-2327 Rev. 03/2017

Conditions of the Permit:

Conditions of the Permit:

________________________________________________________________________________

U.S. Fish and Wildlife Service
Office of Subsistence Management, M/S 121
1011 E. Tudor Rd.
Anchorage, AK 99503-6199

Cut along the dotted line

Wildlife needs your cooperation
Good management helps ensure that animals
will be available to hunt in future years.
Harvest information is a tool that can be used
to help understand and maintain healthy wildlife populations, there-by providing for continued subsistence opportunity.

Remove this Area
Before Mailing

In accordance with the Privacy Act (5 U.S.C. 552a) and the Paperwork Reduction Act (44 U.S.C. 3501), please note the following information. This information collection is authorized by the Alaska National Interest Lands Conservation Act and associated regulations. The Federal Subsistence Board will use this information to manage fish and wildlife resources for subsistence uses. It is our policy not to
use your name for any other purpose. We will maintain this information in accordance with the Privacy Act. Your response is voluntary, but is required to obtain or retain a benefit. We may not conduct or
sponsor and you are not required to respond to an information collection unless it displays a currently valid OMB control number. OMB has approved this information collection and assigned OMB Control
No. 1018-0075. We estimate it will take you about 15 minutes to complete the application and record your harvest. This burden estimate includes time for reviewing instructions, gathering data, and completing and reviewing the form. You may direct comments regarding the burden estimate or any other aspect of the form to the Information Collection Clearance Officer, Division of Policy, Performance,
and Management Programs, U.S. Fish and Wildlife Service, 5275 Leesburg Pike, Falls Church, VA 22041-3803.

OFFICIAL BUSINESS
PENALTY FOR PRIVATE USE $300

BUSINESS REPLY MAIL
FIRST CLASS MAIL PERMIT NO. 12874 ANCHORAGE, AK
POSTAGE WILL BE PAID BY US FISH AND WILDLIFE SERVICE

US FISH AND WILDLIFE SERVICE

NO POSTAGE
NECESSARY
IF MAILED
IN THE
UNITED STATES